Extracorporeal high-pressure therapy (EHPT) for malignant melanoma consisting of simultaneous tumor eradication and autologous dermal substitute preparation

Surgical resection of skin tumors leads to large defects in surrounding normal tissues, which should be reconstructed thereafter using the patient's own tissues taken from the other site. Our challenge is to solve this problem in dermal malignant melanoma (MM) by a novel process, named extracorporeal high pressure therapy (EHPT), in which the tissue containing tumor is resected and pressurized, and the treated tissue is re-transplant back to the same position as a tumor-free autologous dermal substitute. The key points are complete tumor death and preservation of native extra cellular matrix (ECM) by the hydrostatic pressure. We found that high hydrostatic pressure at 200 MPa for 10 min at room temperature is completely cytocidal against MM cells in suspension form, in monolayer form, and even in the solid tumor form. MM tumor-bearing nude mice were established by injected human MM cells intradermally and treated by EHTP. The denaturation of the dermal extra cellular matrices was so mild that the pressurized skin was well engrafted as tumor free autologous dermal tissues, resulting in the complete eradication of the MM without any unnecessary skin reconstruction surgery. This very simple and short pressing treatment was proved to make the tumor tissue to the transplantable and tumor-free autologous dermal substitute, which can be applicable to the other temporally resectable tissues.

A case of lichen planus pemphigoides with autoantibodies to the NC16a and C-terminal domains of BP180 and to desmoglein-1

Lichen planus pemphigoides (LPP) is a rare autoimmune blistering disease that occurs in association with lichen planus (LP). This report describes a 59-year-old Japanese female patient with LPP. The patient first showed LP lesions on her hands, and subsequently developed bullae on her extremities and erosions of the oral mucosa. The patient's serum was positive for IgG autoantibodies against the BP180 NC16a domain, the BP180 C-terminal domain and desmoglein-1. However, a serum sampled one and a half years before the diagnosis of LPP was negative for autoantibodies against BP180 NC16a and BP180 C-terminal domains. These findings strongly suggest that the damage to the basal cells in the LP lesions exposed a sequestered antigen or formed neoantigens, leading to the production of pathogenic autoantibodies for LPP. Most of the previous cases of LPP have produced autoantibodies to the NC16a domain of BP180. This is the first case in which autoantibodies to the C-terminal domain of BP180 were detected. The oral mucosal symptoms in this case may have been caused by autoantibodies to the BP180 C-terminal domain.

Impact of cilostazol on angiographic restenosis after balloon angioplasty for infrapopliteal artery disease in patients with critical limb ischemia

OBJECTIVE

To investigate whether cilostazol reduces restenosis and revascularization after infrapopliteal angioplasty.

DESIGN

This study was a retrospective analysis of a multicenter prospective registry.

MATERIALS AND METHODS

Between February and April 2011, 63 patients (68 limbs, 101 lesions) with critical limb ischemia (CLI) were enrolled. Of these, 32 were cilostazol treated and 31 were the non-cilostazol-treated group. Outcome measures were binary restenosis by angiogram, reocclusion, target lesion revascularization (TLR), limb salvage rate and complete wound healing at 3 months.

RESULT

Procedural success was obtained in all patients. The backgrounds and lesion characteristics of patients with isolated tibial artery disease and CLI did not differ significantly between the two groups. In a lesion-based analysis, binary restenosis and reocclusion were significantly lower in the cilostazol group than in the non-cilostazol group (56.8% vs. 86.0%; p = 0.015, 20.5% vs. 43.6%; p = 0.015, respectively). The TLR was also significantly lower in the cilostazol group (27.5% vs. 52.8%, p = 0.014). After adjustment for covariables, cilostazol was found to be associated with reduced angiographic restenosis, reocclusion and TLR rates in CLI patients at 3 months after infrapopliteal angioplasty. However, it remained unclear whether cilostazol was also associated with improved clinical outcomes.

CONCLUSION

Cilostazol may be associated with reduced restenosis, reocclusion and clinically driven TLR at 3 months after infrapopliteal angioplasty.

Anatomical predictors of major adverse limb events after infrapopliteal angioplasty for patients with critical limb ischaemia due to pure isolated infrapopliteal lesions

OBJECTIVE

To identify anatomical factors associated with major adverse limb events (MALE) after angioplasty as the basis for a novel morphology-driven classification of infrapopliteal lesions.

DESIGN

Retrospective-multicenter study.

MATERIALS AND METHODS

Between March 2004 and October 2010, 1057 limbs from 884 patients with CLI due to isolated infrapopliteal lesions were studied. Freedom-from MALE, defined as major amputation or any reintervention, was assessed out to 2 years by the Kaplan-Meier methods. Anatomical predictors and risk stratification for MALE were analyzed by multivariate analysis.

RESULTS

Freedom-from MALE was 47 ± 1% at 2 years. Lesion calcification, target vessel diameter<3.0 mm, lesion length>300 mm and no below-the-ankle (BA) run-off were positively associated with MALE by multivariate-analysis. The total number of risk factors was used to calculate the risk score for each limbs for subsequent categorization into 3 groups with 0 or 1 (low-risk), 2 (moderate-risk) and 3 or 4 (high-risk) factors. Freedom-from MALE at 2 year-rates was 59% in low-risk, 46% in moderate-risk, and 29% in high-risk, respectively.

CONCLUSION

Target vessel diameter <3.0 mm, lesion calcification, lesion length > 300 mm and no-BA run-off were associated with MALE after infrapopliteal angioplasty. Risk stratification based on these predictors allows estimation of future incidence of MALE in CLI with isolated infrapopliteal lesions.

Evaluation of the efficacy and safety of the combination of gemcitabine and nedaplatin for elderly patients with advanced non-small-cell lung cancer

OBJECTIVE

The aim of the present study was to retrospectively assess the safety and efficacy of the combination of gemcitabine and nedaplatin in elderly patients with advanced non-small-cell lung cancer (NSCLC).

METHODS

Patients ≥75 years with previously untreated NSCLC who underwent chemotherapy consisting of gemcitabine (800 mg/m(2) on days 1 and 8) and nedaplatin (80 mg/m(2) on day 1) every 3 weeks were retrospectively analyzed.

RESULTS

Of the 35 patients, 28 were men and 7 were women, with a mean age of 78 years (range 75-87); 10 patients had stage IIIB disease and 25 patients had stage IV disease. The overall response rate was 45.7% (95% confidence interval 28.8-63.4). The median survival time was 14 months (range 3-44). Grade 3-4 toxicities included neutropenia in 74.3%, thrombocytopenia in 48.6%, anemia in 34.3%, hepatic dysfunction in 11.4%, and infection in 2.9%. There were no treatment-related deaths. There were no differences in response rate and survival between patients aged 75-79 years and patients ≥80 years, although grade 3-4 thrombocytopenia and anemia were significantly more frequent in patients ≥80 years.

CONCLUSION

Our results suggest that the combination of gemcitabine and nedaplatin is effective and well tolerated for selected elderly patients with advanced NSCLC.

[Three cases of Mycobacterium kansasii pulmonary diseases in previously healthy young women]

Mycobacterium kansasii pulmonary diseases account for 20% of cases of non-tuberculous mycobacteria. Most patients are male. However, a recent study has found that radiological examinations in female patients often reveal nodular, bronchiectatic opacities. We describe 3 young women with cavitary opacities. Patient 1 was a 35-year-old woman in whom thin-walled cavitary opacities were detected in the upper lobe during a routine checkup. Sputum examination and fiberoptic bronchoscopy led to a diagnosis of M. kansasii pulmonary disease. Patient 2 was a 23-year-old woman who presented with hemoptysis. Thin-walled cavitary opacities were detected in the right upper lobe. Infection with M. kansasii was diagnosed after a sputum examination. Patient 3 was a 43-year-old woman in whom thin-walled cavitary opacities were detected in the left upper lobe during a routine checkup. Infection with M. kansasii was diagnosed after a fiberoptic bronchoscopic examination. Patient 1 was successfully treated with rifampicin, ethambutol, and levofloxacin, and patients 2 and 3 were successfully treated with isoniazid, rifampicin, and ethambutol. The possibility of M. kansasii pulmonary diseases should be considered in a previously healthy young woman with thin-walled cavitary opacities in the upper lobe.

Autoantibody against a protease domain of caspase-8 in patients with systemic sclerosis

BACKGROUND

Systemic sclerosis (SSc) is characterized by autoantibodies against various cellular components.

OBJECTIVE

To determine the presence or levels of antibodies (Abs) against a protease domain (PD) of caspase-8 and their clinical relevance in SSc.

METHODS

Anti-caspase-8 PD Ab was examined by enzyme-linked immunosorbent assay and immunoblotting using human recombinant caspase-8 PD. Caspase-8 activity was evaluated by spectrophotometric detection of cleavage from p-nitroanilide-labeled IETD, a substrate of caspase-8.

RESULTS

IgG anti-caspase-8 PD Ab levels in patients with SSc, systemic lupus erythematosus, or dermatomyositis were higher than in normal controls (CTL). Furthermore, anit-caspase-8 PD Ab levels in limited cutaneous SSc (ISSc) patients were elevated compared to diffuse cutameous SSc (dSSc) patients. To investigate the clinical correlation, laboratory findings were compared between SSc patients with high levels (>the mean+2SD of CTL) of anti-caspase-8 PD Ab and those with low levels. SSc patients with high level exhibited lower frequency of male and decreased C-reactive protein levels relative to those with low levels. Immunoblotting showed the anit-caspase-8 PD Ab was present in all SSc patients examined, while it was also detected in 75% of CTL. Caspase-8 activity was inhibited by IgG isolated from sera of SSc patients and CTL, although inhibitory effect was greater in SSc patients than CTL.

CONCLUSION

These results suggest that immune response to caspase-8 occurs in healthy individuals, although it is greater in patients with systemic autoimmune diseases including SSc. Furthermore, high level of anti-caspase-8 PD Ab may be a serological indicator for a milder SSc subset.

Immune response against cell-wall skeleton of Mycobacterium bovis BCG at the inoculation site and peripheral lymphoid organs

We reported in the previous paper that highly purified cell-wall skeleton of M. bovis BCG (SMP-105) eliminated lymph node metastases and primary implanted tumor, presumably by generating tumor immunity, employing guinea pigs. In this paper, we investigated the immune reactions to elucidate the mechanisms of antitumor activity. Twenty-four hours after intradermal injection, inflammatory cells were seen migrating to the inoculation site. Massive infiltrations of lymphocytes were observed on day 7, when a large amount of SMP-105 was still observed in the dermis. Several chemokines attracting neutrophils and monocytes, detected by TaqMan RT-PCR, were induced rapidly and declined 72 h post-injection, but most increased again on day 7, consistent with the pathological findings of lymphocyte infiltration. Activation of lymph node cells was investigated using mice. Upon stimulation by SMP-105 in vitro, the draining lymph node cells collected from mice treated with SMP-105 produced interferon-γ (IFN-γ), whereas, lymph node cells did not release IFN-γ when prepared from mice treated with OK-432. This evidence prompted us to assume that SMP-105 functioned as T cell antigens. Intracellular cytokine analysis demonstrated that IFN-γ was mainly attributable to CD4-CD8+αβT and CD4-CD8-αβT cells. In conclusion, oil-in-water emulsion of SMP-105 resided for a long time at the inoculation site and activated T cells, probably recognizing SMP-105 itself. The strong tumor eliminating activity of SMP-105 may be explained by the boost of generating tumor immunity via positive feed-back from T cells reacting to it, and CD4-CD8+αβT and CD4-CD8-αβT cells may distinguish SMP-105 from other synthetic adjuvants.

Injection of cell-wall skeleton of Mycobacterium bovis BCG draining to a sentinel lymph node eliminates both lymph node metastases and the primary transplanted tumor

Based on recent developments in innate immunity, we focused on a microbial immunostimulator for cancer immunotherapy. If innate immunity is properly activated, tumor antigens distributed endogenously in cancer patients will be exploited to activate tumor immunity. We chose the cell-wall skeleton of M. bovis BCG (BCGCWS) and investigated the potential of monotherapy without exogenous tumor antigens. We used strain 2 guinea pigs bearing syngenic line 10 hepatoma, which is an excellent disease model of spontaneous lymph node metastasis, and examined the tumor-eradicating activity of highly purified BCG-CWS (SMP-105), excluding the effect of local inflammation on tumor growth. SMP-105 eliminated both established metastases and the implanted tumor, when injected into different but not distant sites from the tumor, whereas, when injected into the opposite side, neither metastases nor the primary tumor was eradicated. SMP-105 was observed in the draining lymph node engulfed by phagocytes, presumably macrophages or dendritic cells, but was not detected in distant lymph nodes or the spleen. It took about 2 weeks until the tumor-eliminating effect was observed. Taken together it is considered that macrophages or dendritic cells were activated by SMP-105 and encountered tumor cells in the sentinel lymph node to generate tumor immunity during the lag time. In conclusion, we suggested the potential of mono-therapy with a strong immunostimulator and that SMP-105 is a most promising agent for cancer immunotherapy. Separate injection from tumor draining to a sentinel lymph node using classical guinea pig models will be a useful method for investigating immunostimulators.

Involvement of gaseous low molecular monoxides in the cutaneous reverse passive Arthus reaction: cytoprotective action of carbon monoxide

The deposition of immune complexes (IC) induces an acute inflammatory response with tissue injury, for which the involvement of nitric oxide (NO) and carbon monoxide (CO) has been suggested. NO is induced by NO synthase (NOS) and CO is generated by haeme oxygenase (HO). Among HO isoenzymes, HO-1 is an induced type. To assess the role of NO and CO in the pathogenic process, the cutaneous reverse passive Arthus reaction was examined using NOS inhibitor, HO-1 stimulator and HO-1 inhibitor. To evaluate the reaction we considered oedema, tumour necrosis factor-alpha, interleukin-6, and neutrophil number. The values of these four parameters were significantly reduced in mice treated with HO-1 stimulator as compared with the positive control mice. Quite the reverse was observed in mice treated with HO-1 inhibitor. These results suggest that the HO-1/CO signalling pathway is a therapeutic target for human IC-mediated disease.